28 April, 2014

The Psychology of Migraine: Not just another headache

Spring 2002, that’s when it all started. I was in boarding school. Nothing dramatic happened prior to it; no physiological change, no mental trauma, no depressive spell.  It was like every other day, when it seemed like a parasite had woken up from its slumber, in my brain. It started stinging from the inside, and it has been doing so recurrently ever since.

Why am I doing this? There’s a certain comfort in expressing one’s disability. But, the dictionary has always felt really scarce whenever I’ve endeavoured to express my pain. Most chronic pain sufferers experience plethora of irrepressible thoughts; migraine is no different. Once these thoughts are externalized, there’s a better chance to view them objectively and carry out a renewed conscious effort to defeat the pain.
There is evidence of trepanation being performed on skulls over 9000 years old. Trepanation is an ancient surgical intervention in which a hole was drilled into human skull to treat brain related diseases such as migraines or so the cave paintings indicate (Bothwell, 1963). Some believe that the holes were an escape route for evil spirits trapped in the brain. Others opine it might have been an ancient version of lobotomy. I wonder if it helped, it certainly feels like there’s a parasitic entity trapped in their scratching my veins, drilling in my Dura mater and wrenching my eyes in.

The exact cause of migraine has not been fully understood (Migrainetrust, 2014).Range of factors and events trigger a migraine attack. These triggers vary in different individuals. Common triggers include change in routine, mental stress, weather changes etc. Typical migraine attack lasts 4 to 72 hours.  Plus, as the cause of migraine is unknown, a definite cure is yet to be discovered. There are various treatments used to ease the migraine symptoms (aura, headache, nausea etc.), however, the effect of these treatments is varied from person to person and migraine to migraine (NHS, 2014).

Currently, there are no tests to diagnose migraine; blood tests, MRI and CT scan are conducted to rule-out other medical problems like tumours, blood vessel issues etc. And as the cause (and cure) is still a mystery, there are speculations in the psychological academia that migraine might not be a purely physiological issue and it might have psychological origins too (Feiles, 2012); especially because mental stress is one of the most common trigger of migraine. Not surprisingly, some medical doctors prescribe anti-depressants to prevent migraines i.e. to reduce their frequency. Likewise, psychologists suggest psychotherapies to preclude migraines caused by mental stress and depression.

Migraine, is certainly not a psychological disorder per se, however there are several issues in migraine that clinical psychology seeks to address. Firstly, depression and mental stress are common triggers of migraines. Secondly, chronic pain leads to further depression (WebMD, 2014). Thirdly, some researches indicate migraine and depression as comorbid diseases; those which occur together but none of them causes the other (American Academy of Neurology, 2010). Their comorbidity might be due to genetic reasons. Fourthly, Migraines have been tied to suicide attempts in the news, but the connection is yet to be statistically proven (Fox News, 2012). Hence, in the last decade several research studies have been conducted to find behavioural treatments for migraine or migraine management.

As a sufferer, and a person with keen interest in the behavioural aspect of migraine, I’d like to emphasize the dire need to empathize with migraine sufferers. This becomes particularly crucial if your loved one suffers from migraines. As important it is for you to push them to see neurologists, equally incumbent is that you understand their migraine. During a migraine attack, apart from all the physiological symptoms, I feel frustrated, angry and all-together a different person. I feel like there’s a foreign entity in my brain bombarding me with unpleasant thoughts. I feel like my brain is on fire and cruelly over-loaded. It’s almost like migraine has a personality of its own. Staying calm and collected while you feel someone is pulling the strings inside your brain, can be an arduous mission. Other than that, I feel extremely disabled when I have to readjust my calendar frequently with every migraine attack or when I’m unable to appreciate a gathering because I’m fighting this invisible battle within.

So, if you know someone who suffers from migraines: first things first, please don’t say or think ‘how bad it can be, it’s just a headache’; it’s not! Headache is just a symptom along with several others. Rest can all be accomplished if you try to empathize with the migraine sufferer; ask your loved one to narrate the feelings on the on-set of an attack.  If you are not careful, you might actually be triggering a lot of migraines. Simple things can help cope with a migraine attack; I find that if people use simple words and sentences it helps my over-loaded brain process information better.

A request: If you haven’t been diagnosed with migraine, don’t say ‘I have a migraine today’ when it’s just a headache! I know it sounds fancier, but it actually makes the life of us real sufferers quite difficult. Headache and migraine are not synonymous. There are migraines, such as abdominal migraines which do not involve headache at all.

Lastly, none of what I said above will be more powerful than the artistic illustrations below, which I find to be a very accurate depiction of what I go through 3-4 times a week.

(These pictures have been taken from Migraine Art: The Migraine Experience from Within; a book by Klaud poddol et al. which contains more than 300 powerful illustrations and paintings created by migraine sufferers from around the world. Amazon Link: http://www.amazon.co.uk/Migraine-Art-Experience-within-Within/dp/1556436726)


[1] Brothwell, Don R. (1963). Digging up Bones; the Excavation, Treatment and Study of Human Skeletal Remains. London: British Museum (Natural History). p. 126. 
[2] Migraine Trust (2014). Migraine FAQs. . Retrieved on April 26, 2014, from http://www.migrainetrust.org/faqs
[3] NHS (2014). Treating Migraine. Retrieved on April 26, 2014, from http://www.nhs.uk/Conditions/Migraine/Pages/Treatment.aspx
[4] Feiles, N. (2012). Migraines and Headaches: Can Therapy Help?. Psych Central. Retrieved on April 27, 2014, from http://psychcentral.com/blog/archives/2012/07/20/migraines-and-headaches-can-therapy-help/
[5] American Academy of Neurology (2010). Migraine and Depression May Share Genetic Component. Press Release : January 13, 2010.
[6] WebMD (2014). Depression and Chronic Pain. Retrieved on April 27, 2014, from http://www.webmd.com/depression/guide/depression-chronic-pain
[7] Fox News (2012). Severe headaches tied to suicide attempts. Retried on April 27, 2014, from http://www.foxnews.com/health/2012/03/23/severe-headaches-tied-to-suicide-attempts/


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